a small incident

On Tuesday, I went in to Gleneagles for infusions of Zometa, IVIG 200ml and a shot of Velcade 1.1mg/m2(std 1.3). I expected it to last 5 hours but we went at 9am and left the hospital at 5pm, total 8 hrs.  And why was there an incident?

It was the IVIG and of course me, the overly “sensitized” patient. Sometime last year during an IVIG infusion at the clinic, I went into shock when a second bottle of IVIG was added, I was shaking profusely, became cold and the nurses couldn’t register BP in the arm. Dr immediately administered Benadryl and soon my symptoms stabilized and I went into day-ward to recover.

The next time I had IVIG in June, he pre-med me with Benadryl, and that made me very drowsy.  I had always felt that the reaction was because the infusion time was too fast (within the hour) and the IVIG solution is viscous and cold (as it is kept in the fridge). Therefore I suggested that I did not need the pre-med and Dr T was agreeable. 

At the preparation of IVIG, the bottle was warmed to room temperature and the tubing passed through a warmer generally used for blood transfusion, and infusion rate set at 50ml an hour, thus 4 hours for 200 ml. That should do it, thought me, the “smart-alec” patient. But it was not to be, half way through the infusion, my BP rose to 186/98 and pulse at 116 and rose further. Paul immediately called the clinic and reported my condition. Within minutes, instruction was given to the nurse to reduce the infusion rate to 10ml/hr. Dr T came 15 minutes later and requested the addition of 25ml Benadryl. He explained that indeed I have become sensitized to IVIG, a blood product, though I never had this problem in the first year when I had lots and lots of IVIG. Conclusion, I must be pre-med and doc is almost always right and we cannot taken for grant that everything will work fine even though it has been done before. 

I am very appreciative of my doctor’s willingness to hear my views – Paul said he is an “interactive” doctor. And he has already sounded out the nurses to be very alert to possible reaction, thereby resulting in very prompt action of their part and his response time. It is superb and I am grateful. I highly recommend my doctor to anyone who has any kind of blood disorder. He is very patient centric.